Once close to the UPA, but now cosy with the NDA, the Bill and Melinda Gates Foundation (BMGF), an exceptionally well-endowed private foreign entity, operates in India as a “liaison office”. Thus far, it has not reported to the Ministry of Home Affairs under FCRA (Foreign Contribution Regulation Act) 2010 provisions, even though it has given nearly Rs 1,000 crore to Indian NGOs since 2007, with Rs 178 crore being given to NGOs in India during 2013-14 alone. Records show that the BMGF does not pay any taxes in India, nor is it registered as a society, trust, NGO or company in the country. However, unlike in a similar case, that of the Ford Foundation, the Ministry of Home Affairs has ignored this. Indeed, Home Secretary Rajiv Mehrishi, according to an official working in his ministry, is “appreciative” of the BMGF. This may, of course, be because the organisation has done appreciable work in several areas of public health in India. The Gates Foundation has spent heavily in India, and according to a well-wisher, “has made a considerable difference in matters relating to public health”. A negative point is that the Bill & Melinda Gates Foundation has been accused of promoting the interests of US-EU Big Pharma to the detriment of the pharmaceutical industry in India, which, despite scant assistance from the UPA and its predecessors—all of whom have been in thrall to foreign drug manufacturing entities—has nevertheless emerged as a major factor in the provision of affordable drugs to the underprivileged in all the locations where US-EU pharma giants have been unable to block market access to Indian products.

The expectation of the domestic pharma industry is that Prime Minister Narendra Modi will break the mould of support to videshi giants, rather than their swaseshi competitors and ensure that the machinations of US-EU pharma giants fail, so that Indian pharma products get a level playing field both in India and outside, rather than be discriminated against in the rush to embrace the hyper-expensive products of giant MNCs headquartered in the United States and Europe.

Despite government agencies in both the Centre as well as several states showing utmost consideration to the Bill & Melinda Gates Foundation by facilitating its numerous activities in India, and despite that organisation’s close links with top policymakers in the United States, including reputedly Bill and Hillary Clinton, both that country as well as the EU continue to discriminate repeatedly and unfairly against Indian pharmaceutical products, using fudged assessments of quality as well as multiple other means to ensure that much cheaper (but equally effective) Indian drugs do not find their way to pharmacy shelves in the US and the EU, despite the fact that these have been tested and found effective in India, and would benefit tens of millions of poorer patients. Worse, both the US and the EU aggressively block even the flow of drugs from India to Africa and South America, thereby condemning millions on both continents to death and incapacitation owing to Big Pharma drugs being unaffordable for them.

The BMGF Board has just three people and each is a billionaire: Bill and Melinda Gates and Warren Buffett. Both as a foundation as well as individually, each of these three hyper-rich individuals has invested substantially in US-EU Big Pharma stocks, thereby creating an apparent conflict of interest, while deciding which medication their foundation will champion. As a private foundation, the BMGF is only obliged to report its financial figures to the US government (so as to retain its tax-exempt status) and its functioning is, therefore, opaque in several respects. Each year, tens of millions of dollars get spent in publicity, the money flowing from numerous entities linked to the foundation.

Interestingly, groups funded by the BMGF are being directly embedded within key ministries in the Government of India, as well as in several state governments, notably Bihar, where Chief Minister Nitish Kumar has been in contact with Bill Gates himself. In other words, much of government policy in the field of health is getting outsourced to foreign agencies linked to the very drug multinationals who are working overtime to choke or to control India’s domestic drug industry.

However, it bears repeating that several useful campaigns have been launched by the BMGF. A source in the US described Melinda Gates as “the inspiration behind the foundation”. He added that she was “fully committed to improving public health in poor countries, especially among women and children” and that India was “a special concern to her”.

Almost always, US-EU Big Pharma products seem to be preferred over Indian alternatives when suggestions for vaccines and other drugs are made to governments by the BMGF, including for programmes in this country. This is despite the benefit to human life and welfare of the generics industry in India, which has become a special target of Big Pharma and their faithful cohort of regulators in both the US as well as the EU. This despite a growing clamour in both countries for abandoning the present path of giving the profit margins of huge pharmaceutical conglomerates in the US and the EU preference over the right of citizens to affordable medicine. Lobbying in the US by pharma companies (including those with manufacturing facilities in India) ensured that India was placed, on 30 April 2015, on the Priority Watch List in order to dilute its patent protection against attempts to create a Big Pharma monopoly in India. Surprisingly, a source in New York claimed that Economic Advisor to the Ministry of Finance, Arvind Subramanian had, in an earlier incarnation, “lobbied fiercely within the US Congress to impose sanctions on cheaper Indian drugs, thereby demonstrating the reach of Big Pharma in policymaking circles in India”. As part of its efforts at shutting down pharma production in India, the US Food & Drug Administration (FDA) issued notices to all the Indian facilities of Novartis, while the EU banned as many as 700 GVK products from its “open and free” market.

The BGMF funds international NGOs such as GAVI and PATH, which follow its policy of favouring the brands produced by US-EU companies such as Ely Lilly, Pfizer, GSK, Merck, Novartis and other such companies known for the high price of several of the medicines marketed by them. Although exact figures are difficult to come by, a health expert claimed that the “intolerably high prices of critical drugs produced by Big Pharma have resulted in as many as 38 million premature deaths in underdeveloped countries during the past decade”, and that this figure would have been “much more in case civil society groups in Europe had not agitated successfully for entry to cheaper substitutes from India for several extortionately priced drugs for killer diseases produced by pharma conglomerates in the developed world”. Because of the immense reach of Big Pharma as well as the BMGF, sources preferred to remain anonymous. This is in contrast to countries such as the UK, where whistleblowers have proliferated openly. Last month, the well-regarded UK based “Global Justice Now” brought out a report which detailed the awesome power of the BMGF, which in less than a decade has spent more than a billion US dollars on “advocacy”. In India, according to a health activist, “almost every health correspondent is being bombarded with favourable information about the BMGF”, and perhaps as a consequence, both in television as well as in print, negative comment on the giant organisation is almost zero”. However, it must be said that the foundation has several well-wishers, each of whom testifies to its immense pool of good work in India, and its generosity in funding health programmes and health professionals.

Interestingly, the Global Health Strategies (GHS) PR company, which is active in promoting goodwill for the BMGF, has been active in global campaigns designed to show that India is a country where violence against women and children is on the rise. Such negativism about the country has not dimmed its support within the political class in India, which extends across the political spectrum, with P. Chidambaram, Nitish Kumar and Kapil Sibal known to have a favourable view of the BMGF. In the case of Sibal especially, his personal contacts with the foundation are described as “frequent and close”. The foundation is also a member of the Global Investing Impact Network (GIIN), established in 2007 at a meeting chaired by the Rockefeller Foundation, and which contains such entities as JP Morgan and Goldman Sachs, known for their predatory search for profits from underdeveloped countries. It needs to be remembered that several such investors are active in the commodity speculation that has boosted prices of food staples in India. Recently, a small group of speculators based in Mumbai boosted the price of arhar dal, causing mass distress before the government finally moved. Speculation by cartels has been responsible for much of the rise in prices of several essential commodities during the Manmohan decade as well.

Another US-based organisation associated with BMGF is PATH (Program for Appropriate Technology in Health). This was involved in a vaccine trial, which caused deaths and illnesses among young girls. From 2009 onwards, 23,500 girls aged 9-15 were given vaccines which were intended to prevent cervical cancer. The trials were conducted in Vadodara in Gujarat and Khammam in Andhra Pradesh, both states in which the Bill & Melinda Gates Foundation had extensive influence. A vaccine (Gardasil) was produced by Merck and another (Cervarix) by Glaxo Smith Kline. By 2010, there were at least five deaths within the group of young girls in Andhra Pradesh and two in Gujarat. Had these taken place in the US, both companies would have had to pay billions of dollars in damages rather than escape with a much smaller financial liability. Also, unlike the US, in India the legal system means that suits and verdicts get delayed for decades. The PATH fiasco in both states is still winding its way through the courts and seems unlikely to get settled anytime soon.

Such comparatively derisory costs and penalties when compared to mishaps in trials conducted in the US or the EU are the reason why so many vaccine trials are being carried out by multinationals in India, thereby saving billions of dollars in expenses for pharma MNCs. Other NGOs linked to BMGF are GAVI and PHFI (Public Health Foundation of India), the latter being a wing of the Ministry of Health & Family Welfare (MoHFW), which works closely with operatives from PATH and GAVI. The potential ill-effects of mixing together multiple vaccines in the human body has not been given due attention in the pell-mell rush to approve vaccines for mass testing or usage in India, warn health professionals.

According to press reports in the UK, over half the consent forms used for the Andhra Pradesh and Gujarat vaccine trials had only thumbprints, as most of the parents and guardians were illiterate. The Daily Mail claims that many of the young girls interviewed were unaware that they were being subject to drug trials and that several suffered debilitating side effects. Interestingly, during the period when the trials took place, the BMGF held equity shares in Merck. Had the tests been a success, the vaccines produced by the two multinationals would have been included in the Universal Immunization Programmes of different countries across the globe, thereby generating huge profits for them.

In particular, foreign-made injectable vaccines are a favourite of the BMGF, which—according to a senior Health Ministry official—is seeking to introduce such vaccines into India without a local bridge trial. According to a senior official, the BMGF and its associated NGOs are working to ensure prime position for US-EU pharma products in the Family Planning 2020 and the Universal Immunization Programme. However, another said that such fears are unjustified, and that the foundation “has been of immense benefit to India, especially in the field of women and child welfare”.

Although the BMGF has influence even within the Union Cabinet, in India its reach has not penetrated as far as the Prime Minister’s Office. Both Prime Minister Narendra Modi as well as the Prime Minister’s Office (PMO) are known to have refused to intervene on behalf of the Bill & Melinda Gates Foundation in the matter of government decisions, thereby giving hope to domestic drug manufacturers that PM Modi will not allow foreign pharma giants to establish a monopoly over the domestic market. They regard it as imperative that the PMO point out to the BMGF the lower cost and equal medical effectiveness of Indian drugs over those produced by US and EU companies promoted by the foundation, so that Melinda Gates can fulfil her dream of better conditions for women and children. In the words of a senior official, “there is no way the global movement for better health launched by Bill and Melinda Gates can succeed without ensuring that a level playing field be given to Indian producers rather than relying only on the offerings of mega MNCs known for price gouging even in medicines essential for life”.

Hopefully, the acknowledged idealism of Melinda Gates will prevail over the commercial instincts of Bill Gates and Warren Buffett, so that lower-cost options from India are given their due in the substantial work conducted globally by the Bill & Melinda Gates Foundation.

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About Prof. M. D. Nalapat

Prof. Madhav Das Nalapat (aka MD Nalapat or Monu Nalapat), holds the UNESCO Peace Chair and is Director of the Department of Geopolitics at Manipal Academy of Higher Education, India. The former Coordinating Editor of the Times of India, he writes extensively on security, policy and international affairs. Prof. Nalapat has no formal role in government, although he is said to influence policy at the highest levels. @MD_Nalapat

MD Nalapat's anthology 'Indutva' (1999)

In 1999, Har-Anand published Indutva an anthology of MD Nalapat's 1990s columns from the Times of India. The individual columns are posted here, in 1998 and 1999 of the blog archive, though the exact dates of publication are uncertain.